Fluoroscopic, EMG-guided injection of botulinum toxin into the longus colli for the treatment of anterocollis

Glass, Graham A.; Ku, Stephen C; Ostrem, Jill L.; Heath, Susan; Larson, Paul

doi:10.1016/j.parkreldis.2009.01.006

Cited by 39 publications

(18 citation statements)

References 6 publications

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“…Dystonic anterocollis can be challenging because the responsible muscles often cannot be identified by physical examination. Some have advocated BoNT treatment of deep pre-vertebral neck muscles with fluoroscopic guidance, when anterior neck muscles such as the sternocleidomastoids or scalene muscles are not overactive [34, 35], although responses are still variable. Patients with pain out of proportion to muscle pulling may also be more difficult to treat, especially if the pain derives from processes that are not directly addressed by BoNT, such as orthopedic issues or radiculomyelopathy.…”

Section: Discussionmentioning

confidence: 99%

Botulinum toxin treatment failures in cervical dystonia: causes, management, and outcomes

et al. 2016

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Botulinum toxin (BoNT) is highly effective in the treatment of cervical dystonia (CD), yet a significant proportion of patients report low levels of satisfaction following treatment and fail to follow-up for repeated treatments. The goal of this study was to determine the reasons some patients have unsatisfactory responses. A total of 35 subjects who came to our center requesting alternative treatments due to unsatisfactory responses following BoNT treatment for CD were evaluated. Included were 26 women and 9 men with an average age of 57.1 years (range, 25–82 years), and an average duration of illness of 12.5 years (range, 1–55 years). Details of unsatisfactory BoNT treatments were methodically collected by a movement specialist using a standardized intake form, including provider subspecialty, product used, number of satisfactory or unsatisfactory trials, doses given, specific muscles treated, use of electromyographic guidance, side effects, and tests of resistance. The specialist then provided repeat treatments if indicated, and followed each case until the reasons for unsatisfactory outcomes could be determined. Multiple reasons for unsatisfactory outcomes were found. They included suboptimal BoNT doses, suboptimal muscle targeting, intolerable side effects, complex movement patterns, discordant perceptions, and incorrect diagnoses. Only 1 patient was functionally resistant to BoNT. Of 32 subjects who received repeat BoNT treatments, 25 (78%) achieved satisfactory responses after revision of the original treatment plan. These results indicate that the majority of unsatisfactory responses to BoNT treatment of CD were caused by correctible factors and imply a need for improved education regarding optimal treatment methods.

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Section: Discussionmentioning

confidence: 99%

Botulinum toxin treatment failures in cervical dystonia: causes, management, and outcomes

et al. 2016

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“…101,102 Among patients with cervical dystonia, those with prominent anterocollis can be more difficult to treat. 103 Deep injections into pre-vertebral muscles have been advocated, 104,105 although responses vary. For laryngeal dystonias, spasmodic adductor dysphonia responds more predictably than spasmodic abductor dysphonia.…”

Section: Treatmentmentioning

confidence: 99%

Diagnosis and Treatment of Dystonia

2015

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Synopsis The dystonias are a group of disorders characterized by excessive involuntary muscle contractions leading to abnormal postures and/or repetitive movements. There are many different clinical manifestations and many different causes. A careful assessment of the clinical manifestations is helpful for identifying syndromic patterns that focus diagnostic testing on potential causes. If a cause can be identified, specific etiology-based treatments may be available. However, in the majority of cases, a specific cause cannot be identified, and treatments are based on symptoms. Treatment options include counseling and education, oral medications, botulinum toxin injections, and several surgical procedures. A substantial reduction in symptoms and improved quality of life can be achieved in the majority of patients by combining these various options.

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“…deep prevertebral paraspinal muscles, which cannot be reached without radiographic guidance. 74,75 Even with guidance, many patients with anterocollis still fail to respond, so the reasons for poor outcomes in this subgroup remain unclear. The use of botulinum toxins has substantially reduced the numbers of patients undergoing surgical procedures such as peripheral denervation, although surgery is still useful in some cases.…”

Section: Adult-onset Focal Dystoniasmentioning

confidence: 99%

The focal dystonias: Current views and challenges for future research

et al. 2013

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The most common forms of dystonia are those that develop in adults and affect a relatively isolated region of the body. Although these adult-onset focal dystonias are most prevalent, knowledge of their etiologies and pathogenesis has lagged behind some of the rarer generalized dystonias, where the identification of genetic defects has facilitated both basic and clinical research. This summary provides a brief review of the clinical manifestations of the adult-onset focal dystonias, focussing attention on less well-understood clinical manifestations that need further study. It also provides a simple conceptual model for the similarities and differences among the different adult-onset focal dystonias, as a rationale for lumping them together as a class of disorders while at the same time splitting them into subtypes. The concluding section outlines some of the most important research questions for the future. Answers to these questions are critical for advancing our understanding of this group of disorders, and for developing novel therapeutics.

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Fluoroscopic, EMG-guided injection of botulinum toxin into the longus colli for the treatment of anterocollis

Cited by 39 publications

References 6 publications

Botulinum toxin treatment failures in cervical dystonia: causes, management, and outcomes

Botulinum toxin treatment failures in cervical dystonia: causes, management, and outcomes

Diagnosis and Treatment of Dystonia

The focal dystonias: Current views and challenges for future research

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